Patients exemplifying one of these scenarios require careful assessment but may still be able to make their own decisions. Some abrupt mental status changes, for instance, are only temporary. Some patients refuse treatment for reasons that may be unusual or idiosyncratic but are not irrational when examined in more detail. Other patients consent to treatment without apparent consideration of risks and benefits because they have already decided to follow the recommendations of their physician. Many patients with neurologic or psychiatric conditions,2,3 or those who are younger than 18 or older than 85 years, are able to make decisions about some aspects of their medical care.